Vibrio Vulnificus Infections in the US

Public health officials in Connecticut, New York, and North Carolina detected cases of Vibrio vulnificus infection and launched investigations while spreading information through press releases and a CDC Health Advisory Notice. The quick action taken in response to the cases highlights the essential link between climate change, environmental conditions, and the occurrence of waterborne pathogens such as V vulnificus. The surge in infections throughout 2023, especially after periods of heat, shows the importance of ongoing alertness and the implementation of preventive strategies for public health.

Between July and August 2023, there were a total of 11 reported cases infected with V vulnificus, in North Carolina (7 cases), Connecticut (2 cases), and New York (2 cases). The average age of the patients was 70, with ages ranging from 37 to 84 years, and 7 of the patients were male. Out of 10 patients for whom information was available, 9 had at least one pre-existing condition. Out of the 11 cases, 4 patients developed septic shock, and 5 patients died.

“As coastal water temperatures increase, V vulnificus infections are expected to become more common,” according to the CDC. "This highlights the importance of public awareness and preventive measures, such as avoiding wound contact with brackish or salt water and raw seafood, and thoroughly cooking oysters and other seafood before consumption.”¹

In 6 instances, the probable path of infection was through waterborne transmission due to wounds in marine or estuarine waters. Furthermore, 2 cases among residents of North Carolina were likely caused by a hand-cut incurred during the handling of raw seafood. A case from Connecticut was linked to the consumption of raw oysters in a different state, and another individual from North Carolina reported exposure to both a wound in brackish water and the consumption of raw oysters.

“V vulnificus can cause life-threatening, necrotizing skin infections that warrant urgent surgical debridement. Presentation typically occurs after an open wound is directly exposed to flood waters. Patients often present with systemic signs of illness, including fever, hypotension, sepsis, and bullous skin lesions.”²

The emergence of these cases following heat waves in the US indicates a link between the incidence of vibriosis and environmental conditions that promote the growth of Vibrio, including increased water surface temperatures and reduced salinity. Although the cases identified in July through August cannot be directly blamed on the heat waves alone, the association between these environmental conditions and the occurrence of V vulnificus infections is thoroughly established.

The V vulnificus outbreaks in the summer of 2023 underscore the link between climate change, environmental shifts, and waterborne pathogen proliferation. Health authorities' responses are necessary to monitor water temperatures and salinity.

Reference

1. CDC. Notes from the Field: Severe Vibrio vulnificus Infections During Heat Waves — Three Eastern U.S. States, July–August 2023. Published February 1, 2024. Accessed February 22, 2024. https://www.cdc.gov/mmwr/volumes/73/wr/mm7304a3.htm?s_cid=mm7304a3_w
2. Chandler, E. In the Aftermath: Post-Hurricane Infections. Contagion. Published September 17, 2023. Accessed February 22, 2024. https://www.contagionlive.com/view/in-the-aftermath-post-hurricane-infections